Low-Carb Diabetes: What You Need to Know

A powerful new study makes the case that restricting carbohydrates should be the first therapy in Type 2 diabetes. If you want to follow the researchers’ advice, here are some things to know.

• What does carbohydrate mean ? Carbohydrates (“carbs”) are sugars, starches, and fiber. They are plant foods the body uses for energy. Sugars are a major component of the foods that taste sweet, including fruits. Starches are a major portion of grain foods like bread and pasta. Some vegetables, such as potatoes and peas, are also full of starch.

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Starches break down into glucose in your body. Both sugars and starches will raise your blood glucose level if you have diabetes or prediabetes.

Fibers usually do not break down in the body. They move through the digestive tract to the large intestine. There they are fermented by intestinal bacteria into valuable nutrients called short-chain fatty acids (SCFAs).

Restricting carbs means eating much less sugar and starch. It is the simplest way to keep glucose levels down.

• How low is low? A typical American adult eats 200–300 grams of carbs per day, about 100 of which is sugar, according to the U.S. Department of Agriculture (USDA).

Anything less than 200 grams (about seven ounces) of carbs a day could be called “low,” but most advocates of low-carb eating call for much less. Dr. Richard Bernstein says to eat 6 grams of carbs at breakfast, a maximum of 12 grams for snacks, and 12 grams each at lunch and dinner. Twelve grams is about the amount in one average slice of bread.

Jenny Ruhl, keeper of the website Blood Sugar 101, recommends starting at 15 grams of carbs per meal. Others are much looser in their recommendations. Any reduction in carbs is likely to help, they say. In a comment two years ago, reader Calgary Diabetic wrote: “I think a good definition of low carb would be the amount of carbs per day that you can safely eat and maintain your blood sugar in the normal range at all times.”

You may have to decide for yourself how low you want to go, depending on your meter readings and how you feel.

• How do you know how much carb you’re eating? Packaged foods usually say what their carb content is, but the labels can be tricky to understand. Author Dianne De Mink wrote here about understanding terms like “total carbohydrate,” “net carbohydrate” and “effective carbohdyrate.”

What about unpackaged food? No labels. A good chart of nine thousand or so foods is available from the USDA here. It will tell you how much carb is in a specific quantity of food.

To figure how much food you’re actually eating, you could weigh it. But most people don’t do that anymore. You can estimate it using guidelines that Gary Scheiner, MS, CDE, wrote here. Scroll down to the section called “Learn to estimate portions.”

• What should you eat instead? You have to get calories from someplace, so you will need to replace your starchy and sugary carbs with protein, fat, and/or fiber. Fiber is easy: green vegetables and beans are full of it and other nutrients.

The study in Nutrition referenced at the start of this article suggests fats would be the easiest way for most people to get their calories. They state there is no evidence that consuming fat is bad for diabetes. Protein is good, too, but some protein does convert to glucose in your blood. Does eating fat and protein mean eating lots of meat?

It doesn’t have to. You can get fat from eggs, oils, nuts, seeds, avocados, fish, and some other places. You can get protein from beans, nuts, seeds, fish, dairy products, and soy products such as tofu or tempeh.

A good low-carb diet is balanced. In a comment, our reader Joe wrote, “I do not eat just meat. I enjoy bacon and sausage once in a while. I eat green leafy vegetables, sprouts, broccoli, mushrooms, green peppers, blackberries, blueberries, walnuts, raw almonds in small amounts. I do not eat processed foods, grains, and starchy vegetables for the most part.”

On his high-fat diet, Joe got his A1C down to 4.2 and his cholesterol down to normal. Reader Mark wrote, “My diet consists of berries, some nuts, grass-fed meats (or any red meat), vegetables, and dairy. I have lost over 80 pounds on this diet and reversed my gout, diabetes, blood pressure, and arthritis issues.”

Can you afford it?
You might have noticed that Joe and Mark’s food lists include some pricey things. Nuts and berries and some meats can cost a lot. But there are cost saving ways to go low carb. According to the Low Carb Friends site, these include using discount groceries and buying in large quantities.

One woman wrote about using a whole turkey when they’re on sale. First, roast it for a turkey dinner or two. Pull the rest apart to use on top of salads. Make some Chinese-style stir-fries with a little bit of meat and a lot of veggies (cheap ones include cabbage and lettuce.) Make soup with the rest using low-carb veggies like onions and celery. She does the same thing with chickens.

“Low-carb expert” Laura Dolson of About.com says non-meat proteins like tofu are cheaper than meats. She’s also big on buying in quantity and freezing in plastic bags for later. Low carb can be affordable and tasty.

A couple more notes: 


• Drink more water to deal with by-products of protein and fat metabolism.

• Tell your doctor you are changing your diet. You may need less medication.

• Learn more — there are dozens of low-carb sites and books you can check out, including the ones linked in this article. Good books are Richard Bernstein’s Diabetes Solution, Mark Hyman’s The Blood Sugar Solution, and Jenny Ruhl’s Blood Sugar 101.

How is having diabetes similar to the Apollo 13 mission? Bookmark DiabetesSelfManagement.com and tune in tomorrow to find out from Scott Coulter!

  • RAWLCM

    David,
    A recent news story highlighted a study financed by a vegan advocacy group. They ended up recommending a vegan diet for diabetics as a treatment for neuropathy. From my understanding, a high-protein vegan diet would be pretty high in carbs as well -they were recommending beans and other legumes as protein sources. Any feelings on this? To me it seems contraindicated.

    • RAWLCM, You are right that it’s difficult to eat a vegan diet with very low carbs. Maybe not impossible though. Beans do have a fair amount of carbs but you need to check your sugars after eating some to see how they affect you. Nuts and soy proteins are other protein sources that don’t have much carb.

  • terrilynnmerritts

    I am a type 2 diabetic. I got on the Atkins diet, went through induction, on-going weight loss, pre-maintenance then maintenance. I lost 220 pounds, made it possible to drop meds and keep diabetes under control with diet, got off blood pressure and cholesterol meds, and literally saved my life.

  • Donna Verdier

    Another good book: How to Think Like a Pancreas, by Gary Scheiner.