Lowcarb diets for diabetes control?

May 27, 2012 10:33 PM

High-fat low-carb diets for diabetics?

Asking for someone else:

Have any of you done/gone on a low-carb diet to control blood sugar for type-2 diabetes? Can you suggest some general guidelines - how many carbs in a day constitutes 'low-carb', how much fat you need, if your blood sugar levels have stablised, etc. Have you experienced any negatives from this diet - for instance, I've heard that high protein intake affects the kidneys?

Thank you!

zennish: the person asking does have a doctor and knows this is all anecdotal. From what I understand, they've always eaten a lowish-carb diet with approx 100g carbs a day, but it either isn't controlling glucose levels accurately any more or they've overestimated their carbohydrate intake. Any advice/stories re. effectiveness/ineffectiveness of low-carb diets would be appreciated.

posted by zennish to health & fitness (18 answers total)

Also: weight loss is not the target here - the person in question is about ten pounds underweight.
posted by zennish at 10:45 PM on May 27, 2012

Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.

Westman et al. ""The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus" (Nutrition & Metabolism 2008, 5:36)
posted by bigtex at 11:26 PM on May 27, 2012 [2 favorites]

The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

Yancy et al. "A low-carbohydrate, ketogenic diet to treat type 2 diabetes" (Nutrition & Metabolism 2005;2:34)
posted by bigtex at 11:30 PM on May 27, 2012 [1 favorite]

The Atkins Forum has a forum with and for people who are eating low-carb to control diabetes. I realise your friend is not specifically looking to do Atkins (and that board follows old-school Atkins anyway) but that is a very useful resource to read through if you're interested in the experience of others with diabetes.

"Low" in a low carb diet will vary between individuals. It can be as low as 20 for loss, 30 for maintenance.
posted by DarlingBri at 11:39 PM on May 27, 2012

I am currently pre-diabetic and have had gestational diabetes. Twice.

My understanding of this is that the most important thing, apart from SUGAR IS EVIL, is to have the carbs you do eat, be low GI.... so you don't have those big peaks and troughs.

I saw a dietician at our local teaching hospital just three or so weeks ago, and she said that avoiding carbs is actually really bad.

I know you said your friend has seen a doctor, but my feeling is that they don't spend 6 years at university studying diet scientificially. Dieticians do.

Have you seen a dietician?

I also count all my calories and weigh my portions. I was outraged at how small a serving of breakfast cereal was. SURELY THERE WAS A MISTAKE, THAT IS NOT ENOUGH TO SATISFY A HUMAN BEING OVER THE AGE OF TWO!!! But alas, actually, it is. We all eat far too much. I knew that intellectually, but when I actually started re-training myself and looking at quantities, you can't actually eat very much carb at all.

I now eat a lot LOT of broccoli and have really cut down on my bread, pasta, rice and potato. I eat broccoli and cauliflower instead of most of them. Except bread. Poached egg and vegemite just isn't the same on broccoli.

Dal and milk and yoghurt are carbs.... so it's hard to avoid it healthfully. With the strongest, most empathetic language I can use, please tell your friend to see a dietician. And if it's completely out of the question for some reason..... Cop a look at this site. It's one of Australia's most respected universities.
posted by taff at 1:13 AM on May 28, 2012 [3 favorites]

If your friend is not already familiar with Dr. Richard Bernstein, I highly recommend this book: Dr. Bernstein's Diabetes Solution. This doctor has been controlling his own type 1 diabetes with a very low carb diet for years (he takes insulin as well, but attributes his lack of diabetic complications to his super-tight control of his blood sugar with the diet.)

It's been a long time since I read it so I don't remember how many grams of carbs he allows, but I'm sure it was much lower than 100 g per day. He doesn't allow fruit or so-called "good carbs" on his plan at all, as I recall.

Though the doctor is type 1, he covers type 2 very thoroughly in the book. There is also a lot of good general information and lifestyle advice for diabetics, it's not just a diet book.
posted by Serene Empress Dork at 3:59 AM on May 28, 2012 [2 favorites]

The Blood Sugar 101 website is an excellent resource for the low-carb approach to managing blood sugar. She reads, reviews, and links to studies regarding blood sugar control.

Blood sugar control is so individualized that there is no way to say how many carbs a diabetic can eat and still maintain tight control. The only way to find that answer is to test and experiment until your friend can determine which carby foods are okay and which should be avoided.

My husband has been diabetic now for three or four years. The dietician he saw gave him very high targets of carbs per meal (IIRC, it was 30 grams for breakfast, 45 for lunch, and 60-75 for dinner) which, if he followed that plan, would have resulted in a very high A1C.

Based on our experience of managing his blood sugar, we've come to believe that the ADA (American Diabetic Association) is either woefully misguided or is corrupted by the grain producers. They advocate eating lots of pasta and whole grains, both of which cause drastic blood sugar spikes in him and other diabetics we know. Cutting out most grains and starches, on the other hand, keeps his A1C in the 5.9-6.1% range.
posted by DrGail at 4:18 AM on May 28, 2012 [3 favorites]

Greetings, I was diagnosed as insulin resistant and nearly diabetic last year in January. I started a ketogenic diet based on Atkins induction. My blood work was normal within 5 weeks and has been for over a year. I lost 60 lbs, my body fat is down to 9% (at 50), my cholesterol is normal, my BP is normal.
I eat no sugar at all, no bread, no rice, no potatoes. I use whole grain or flax low carb wraps/tortillas for bread and Shiritaki for noodles. I drink water, tea, coffee only. I aim for 20 grams of carb per day and less than 8 per any one meal. i eat only tiny amounts of low GI fruit occasionally.
My doctor says I have dodged the Diabetes bullet along with several others.
Good luck.
It has proven to be the best health choice ever for me.
posted by StUdIoGeEk at 5:06 AM on May 28, 2012 [1 favorite]

South Beach was originally conceived as a diet for cardiac patients with type 2 diabetes. So, reading Agatston's book would probably be good background, even if your friend didn't plan to follow the diet.
posted by lodurr at 6:45 AM on May 28, 2012

I don't have diabetes myself but my dad has Type II diabetes which he manages following a lowish-carb diet. I would like him to go even lower carb than he does -- but it's practically difficult for him living in India. I would say that he eats about 60-80 g of carbohydrates a day, in the form of whole-grain rotis and fruit. He has experienced some amount of success but I can't help feeling he would do even better with more fat and even less carbs, but it's difficult to go against the advice of his doctors in India, all of whom push a low-fat, vegetarian diet, high in whole grains -- this is a cultural thing I feel.

I personally have followed a low-carb, high-fat diet myself, to lose weight and to control prediabetes symptoms, such as high fasting blood sugar. I experienced great success with this, losing about 60 lbs (normal BMI) and reversing those early prediabetic symptoms I had (my hBA1c was 5.2 last I checked, fasting blood sugar 79). Since I have diabetes on both sides of the family (dad, paternal aunt, maternal grandmother all have diabetes) -- this is a very big deal for me. Like StUdioGeEk mentions above, I feel that I dodged the diabetes bullet and have never felt healthier in my life. I detailed my advice for low-carb, high-fat diets in general in this comment here. Following the diet would not be very different in the case of Type-II diabetics either.

I'd recommend Bernstein's Diabetes Solution as well that Serene Empress Dork mentioned above.

I want to note that this is a high-fat, low-carb diet not a high-protein diet. In fact your percentage of protein in your diet is not going to change substantially (and it shouldn't) -- you'll essentially be reversing the proportions of carbs and fat compared to the standard American diet, leaving protein unchanged. So your kidney function should be fine. For what it's worth, after 6 years of low-carb eating, I did the standard kidney function tests and everything was normal. If you find that you're eating more protein than earlier, up your levels of fat. You will also find that if you eat low-carb, high-fat, your appetite will drop (a big reason for the weight loss that people experience) and you will probably end up eating less total calories and less protein even though the proportion of your diet will be roughly the same. I wouldn't recommend South Beach so much -- it sounds great in theory -- low fat and low carb -- but it doesn't give you the appetite suppressing effects of extra dietary fat and increases your protein levels beyond what's optimal, IMO.
posted by peacheater at 7:21 AM on May 28, 2012

I know there are at least a couple of diabetics who hang out at /r/keto. There's a ton of information in the sidebar there as well.

I do keto/LCHF myself if you have specific questions I can help you with, but I do it for weight loss, not diabetes.

I'd be extremely skeptical of dieticians if I were you.
posted by callmejay at 7:32 AM on May 28, 2012

I'm adding another vote for Dr. Richard Bernstein's approach. Serene Empress Dork already linked to his book; he also has a website. I would definitely suggest that your friend get the book, though. It's exhaustively detailed and answers just about any conceivable question.

Since you asked for anecdata, I'll tell you that Mr. Danaos is an adult-onset diabetic diagnosed about 15 years ago, who is now insulin-dependent. Up until about six months ago, he carefully followed a "balanced" ADA-compliant diet prescribed by a dietician. He also exercised regularly and vigorously. Even so, his diabetes got a little harder to control every year. By January 2012, he required oral medications and both short-acting and long-acting insulin, and his average blood sugar readings were 160 to 180 mg/dL.

When he adopted Dr. Bernstein's approach, his blood sugar averages started dropping a little every week and are currently 90 to 110 mg/dL. He has cut his long-acting insulin dosage by a third and is getting ready to drop it a little further. He no longer feels hungry all the time. He can skip meals without getting faint. What's more, his blood sugar is much more steady, without the peaks and valleys that used to frighten us both. He feels much better, much healthier, and much more optimistic about his future.
posted by timeo danaos at 8:09 AM on May 28, 2012

I am a Type-2 diabetic, and I have attempted a low-carb, high-fat diet for glucose control. The Bernstein book that everyone is recommending is good, but I found the diet to feel overwhelmingly restrictive as I was reading it. It was better in practice, but the tone of the book just felt to me like "Eat this way if you want to live, be doomed to terrible complications if you don't." I didn't find that motivating, but YMMV (as well as your head space...I may have just not been in the right frame of mind for that presentation).

Realistically, I've been able to eat about 30-40 carbs most days. This does require eating more protein and fat, for me; I was hungry otherwise. My HgAIC was marginally better than it would have been on higher carbs, but I was not taking my medication due to side effects (not recommended!) and my diabetes was not well controlled. Now that I am back on meds--insulin, primarily, in my case--there's no hope for weight loss (again, for me). I'm able to take considerably less insulin than I would be otherwise, and that's something, since I still have to take more than you'd think. So my glucose control is better with low carb, but not good enough to be without medication. I've been diabetic for 25 years, so that's to be expected. Again, YMMV.

My other labs, however...Triglycerides, Kidney Function, Cholesterol...all of these were significantly closer to normal than they've been in a long time---and without the meds for those too. (Yes, I know that was a bad idea). They were marginally above the normal range, except my kidney tests were all in range. In the past, I'd seen Triglycerides of 300+, micro-albumen in the urine sample, etc. None of that now. Triglycerides were 155 (top of "Normal" range is 150). So even though some doctors still get concerned about the effect of all that animal fat and protein on your lipids and kidney function, I saw clear improvements like the Atkins folks and Gary Taubes predicted. My doc will keep checking my numbers, but for now my mind is at ease on that front, and I don't worry about how much fat is too much fat. I just know that you have to eat SOMETHING, and I need the fat for a low-carb diet to be satisfying at all.

As for more concrete advice, since starting the insulin, I have to check my blood sugars before and after every meal. This helps me to understand the effects different carbs have on my blood sugar. I test at least 4 times a day, sometimes more, and that's helped me to see what is okay. Even though it is many carbs, I do not see a significant blood sugar spike from McDonald's oatmeal with blueberries. The same amount of insulin is required to correct for the oatmeal (49 g carbs) as it is for eggs, sausage and cheese (3 g carbs). That's not something a book would have taught me, and I don't know if it's true for everyone. But it's true for me. Cottage cheese seems to be relatively low-carb, but it will raise my blood sugar more than you'd think. Cashews are higher-carb, for nuts and seeds, but they don't affect my blood sugar at all. The Bernstein book helps with these ideas, as it underscores the importance of blood sugar testing. You may be tempted to think that's only for the insulin-dependent folks, but it can really help you make sense of what number and types of carbs are okay for you. Interpreting these results will depend on what, if any, diabetic meds you are on, but if you can afford the test strips or insurance will cover them, testing can only help.

Every forum where you find people following a low-carb, high-fat diet, you will find people who are doing it to treat or avoid diabetes. Most of them will say 100 carbs is a lot in a day. You'll probably see better glucose control at 30-50. No need to go all the way down to 20, as that's for weight loss.

One final note: 10 pounds underweight is definitely not typical for a Type-2 diabetic. It may be unrelated, there may be a documented reason for being underweight, but if I was 10 pounds underweight and not able to control my diabetes, I might be questioning my Type-2 diagnosis---Type-1 treatment may be more appropriate. It's not just "kids get type 1"/"adults get type 2" anymore, some people appear to be 2's and then it becomes apparent that they are really 1's,l and honestly, there are other types in between. The book Think Like A Pancreas has some helpful discussion about the different types of diabetes and what's going on behind the scenes. Otherwise, that book is geared towards the folks who need insulin, but that section might still be helpful.
posted by terilou at 8:18 AM on May 28, 2012 [1 favorite]

Not a personal experience, but I know a lot of Type-2 diabetics who have seen massive improvements by taking a low carb approach (<5>
The current official approach of dieticians right now is MOAR CARBS NO FAT. It's hard to believe but the entirety of the justification of this approach is based on a couple of large, poorly-done studies, then cherry-picking other nutrition studies done after them. It is becoming more and more apparent that this is not an ideal approach for much of the overweight, diabetic, or pre-diabetic population, but the wheels of change move slowly in the nutrition world and people tend to adhere to the party line because it's been advocated so long.
posted by schroedinger at 9:11 AM on May 28, 2012

One final note: 10 pounds underweight is definitely not typical for a Type-2 diabetic. It may be unrelated, there may be a documented reason for being underweight, but if I was 10 pounds underweight and not able to control my diabetes, I might be questioning my Type-2 diagnosis

It may be atypical but not all t2 diabetics are overweight.
posted by rr at 11:51 AM on May 28, 2012 [1 favorite]

Diabetes-wise I seem to be an oddball. I tried Atkins at a 30 to 50 grams of carbs per day. It went well blood glucose-wise for about two weeks. After that, my readings went back to their then-normal high level and didn't budge. Just letting you know a low carb diet isn't necessarily the answer.
posted by deborah at 5:19 PM on May 28, 2012

The treatment for diabetes before insulin could be produced in the lab WAS a very low carb diet. It is such an effective treatment that it essentially 'cures' the disease. But because the medical community is so damn convinced that saturated fat and cholesterol are bad for you, it's not even considered as a treatment any more.
posted by imagineerit at 6:46 PM on May 28, 2012 [1 favorite]

This is fantastic, especially the journal articles. Thank you!
posted by zennish at 6:51 PM on May 28, 2012