Low-Carb Diets and Type 2 Diabetes
When I was diagnosed with type 2 diabetes in 1996, low-carb diets were considered fringe diets. The writings of Dr Richard Bernstein, a supporter of low-carb diets for people with diabetes, were like words shouted into the wilderness. Other physicians didn’t hear them.
However patients did, and did well.
When I told my endo I was on a low-carb diet, she said, "I hope you’re not on Atkins." When I said the same to a physician at Joslin Diabetes Center in Boston, he was aghast. "But that’s what they did in 1910."
This is true. Low-carb diets were able to keep people with type 2 alive for years in the days before insulin or oral drugs. They also helped people with type 1 diabetes, but those patients died after several years anyway, even when on starvation diets, because they were unable to produce enough insulin to keep them out of ketoacidosis.
Insulin, even a little insulin, reduces the formation of ketones, so patients who are able to produce some insulin (most people with type 2 diabetes) will avoid producing so many ketones that their blood becomes acidic, resulting in ketoacidosis, even though they’re still producing some ketones when they eat fat or don’t eat much at all, so they’re living off their own fat. This latter state is called metabolic ketosis to distinguish it from ketoacidosis. Many people, even some physicians, confuse the two states.
Today, the tide is turning, and instead of being considered fringe diets, low-carb diets are increasingly accepted, even by physicians. Even the American Diabetes Association, which for years mandated low-fat, high-carb diets, now says low-carb diets are OK for weight loss, although they still suggest that such diets should be only temporary.
Change is slow.
But more and more evidence is accumulating that low-carb diets perform better than other diets for people with type 2 diabetes. Sometimes it seems as if every day brings a new article making that point.
One review article, scheduled for publication in the journal Nutrition in January, was authored by 26 physicians and researchers and summarizes the evidence in favor of low-carb diets for people with type 2 diabetes. They discuss 12 "points of evidence" for the benefits of low-carb diets for people with diabetes, along with 99 references.
If you’re interested in the scientific support for low-carb diets for people with type 2 diabetes, this is certainly the place to start. The full text of the article is free.
Even the British Medical Journal recently ran an article criticizing low-fat diets.
If you’re interested primarily in losing weight, this Scandinavian blog has numerous examples of people who have lost huge amounts of weight on a low-carb high-fat diet.
I’ve been on a very low carb diet for about 17 years now (many dieticians say no one could stick to such a diet for more than a few months), and except for eating in restaurants and at potluck gatherings, I have no problems with it. I don’t mean I splurge on chocolate cake and spaghetti when I go out. I’ve learned that even a small bite of some fancy dessert at a social gathering will taste overwhelmingly sweet and hence not be too enjoyable. Then this awful sweet taste lingers in my mouth for hours.
I just mean it can be awkward if I don’t plan ahead, which means extra work, and I’m pretty lazy. On a low-carb diet I’m not hungry most of the time, so it’s easy to watch while other people eat if there’s nothing on the table that works for me. At home, I’m so accustomed to eating this way I’m not sure what I’d do if I were suddenly cured.
No diet is perfect for everyone, but people with metabolic syndrome or type 2 diabetes tend to do the best on low-carb diets, and thus such diets are good places to start. Richard Feinman, the first author of the review article I cited, calls this the "default diet." Unless there’s an overwhelming reason to start with something else, start with low carb.
Try a low-carb diet for a month or two and see how things go. If you love bread and hate butter and other fats, you might be unhappy on a low-carb diet. Then you can try something else. If you love butter and cheese and whipped cream and chicken with the skin on, you might be in heaven on a low-carb diet. Who needs bread? If you’ve already tried a low-carb diet on your own and not lost much weight or improved your diabeted control, consider making an appointment with a nutritionist. She or he may help you find hidden sources of carbohydrates in your daily food intake.
Some people think that eating a lot of fat (when you’re not eating carbs, you eat more fat) would make lipid levels increase, but counterintuitively, it’s carbohydrates that make blood triglycerides (fat) go up, and most people see their LDL and HDL levels improve on a low carb diet. LDL can go up, but so does HDL, and the important ratio stays the same or improves.
The great thing about low-carb diets is that they control your blood glucose levels as well as helping you to lose weight. I haven’t lost a ton of weight on my very low carb diet, but when I started it, I didn’t have a lot more to lose, and those last 10 pounds are always the most difficult to get rid of. My BMI is now in the normal range. My last A1c was 5.2.
So if you haven’t done so already, you might look into a low-carb diet to try to control your type 2 diabetes. You and your doctor might be very pleased with the results.
Gretchen wrote for HealthCentral as a patient expert for Diabetes.